tbuckley/cabot-search huggingface dataset:
Impact of proposed 2022 changes to the Merit-Based Incentive Payment System (MIPS) on oncologist performance and reimbursement.
Authors: Vishal R. Patel, Arjun Gupta, S. M. Qasim Hussaini
Journal: Journal of Clinical Oncology (2022)

6 Background: In 2017, the Centers for Medicare &amp; Medicaid Services (CMS) executed a landmark bipartisan legislation aimed at gradually shifting American healthcare from a fee-for-service model to a value-based system. The resulting payment model, MIPS, uses cost and quality metrics to assign clinicians an overall MIPS score, where higher scores correspond to greater payments for practices. In 2018, cost metrics contributed only 10% of this composite score, while quality metrics contributed 50%. Beginning with 2022, the cost and quality categories will be equally weighted (30% each) to encourage clinicians to reduce healthcare costs. As the cost of cancer care is disproportionately high, we investigated the implications of the updated scoring on reimbursements for oncologists and other providers participating in MIPS. Methods: We included physicians participating in the 2018 MIPS Performance Year files. We categorized hematological-, medical, radiation, gynecological, and surgical oncologists as oncologists and delineated those with National Cancer Institute-designated Cancer Center (NCICC)-affiliation. We excluded individuals who were exempt from reporting cost scores due to their MIPS-filing method. We calculated the projected 2022 MIPS composite scores (range, 0-100) by multiplying the 2022 weights by the 2018 component scores. We compared the change in composite MIPS score and the corresponding negative payment adjustments due to reweighing across specialties. Clopper–Pearson 95% confidence intervals were reported. Results: The cohort included 168,659 physicians, of which 163,150 (97%) were non-oncologists and 5,509 (3%) were oncologists. Of oncologists, 1,757 (32%) were at a NCICC. Cost scores (higher is better) for each group were as follows: non-oncologists, 75.2; all oncologists, 65.5; NCICC oncologists, 57.1. Reweighing the 2018 MIPS composite scores with the updated 2022 cost/quality weights resulted in a mean 1.7-point decrease (88.7 to 87) for non-oncologists, a 3.8-point decrease (89.7 to 85.9) for all oncologists, and a 5.2-point decrease (89.2 to 84) for NCICC oncologists. Following the reweighing, the proportion of non-oncologists incurring penalties will increase by 12.8% (95% CI, 12.7%–12.9%); all oncologists by 14.3% (95% CI, 13.2%–15.4%); and NCICC oncologists by 20% (95% CI, 18.1%–21.9%). Conclusions: Beginning with 2022 performance year, federally mandated reweighing of MIPS cost metrics will result in a disproportionate increase in oncologists receiving negative payment adjustments. With a majority Medicare population with new cancer diagnoses, higher patient complexity, and declining operating margins at many oncologic practices, we highlight striking upcoming changes that may inform further optimization of MIPS cost metrics by CMS to ensure oncologists providing high quality care are not penalized.
Implementing a discharge intervention to reduce 30-day readmission and mortality in patients with high-risk cancer: A real-world prospective quality improvement study.
Authors: Michelle M. Chin, Ashlie R Jones, Allison Steyl, Patricia Geddie, Zilipah Cruz, Joanne A Bean, Wendy S Cooper, Tek Vu, Daniela Serafimovska, Terra Warner, Akash Nanda, Nicholas George Avgeropoulos, Susan Stallard, Wasif M. Saif, Margo Shoup, Amy Iarrobino Laughlin
Journal: Journal of Clinical Oncology (2022)

329 Background: One in four patients admitted with metastatic cancer are readmitted within 30 days. We created a bundled multipronged intervention to reduce 30-day readmission, unplanned (ED) visits, and mortality among high-risk stage IV cancer patients. Methods: We conducted a prospective quality improvement study to reduce readmissions and 30-day mortality among high-risk oncology patients. Baseline patients were identified 1/2022-3/2022. The electronic medical record (Epic) was leveraged to automatically identify patients admitted with cancer diagnosis and set risk factors (readmission, low albumin, fluids/antibiotics, head imaging, low oxygen saturation). Dashboard was reviewed three times per week and stage IV solid malignancy confirmed. Starting 3/2022, intervention included three components: coordination of care (CC), patient education and symptom management (PESM), and post-discharge follow-up (PDF). In CC, a dedicated scheduler coordinated visits with the primary oncology team within 7 business days, with options for palliative care, nutrition, and integrative medicine. In PESM, the attending physician was notified, referred to oncology nurse navigation and encouraged to use the oncology urgent care. In PDF, patients were contacted after discharge to collect hospital readmission, unplanned ED visit, mortality outcome and satisfaction. Patients discharged with hospice were excluded. Control charts were used to assess special cause and chi-square to compare pre and post intervention cohorts. Results: As of 6/2022, 36 baseline and 125 patients have been identified. Of 117 discharged patients, 23 were discharged on hospice, of the remaining 94, 98% were contacted by the concierge scheduler and 53% received an appointment within 7 days. Among the intervention patients, the most common tumor type was lung (n = 16), prostate (n = 14), and colon (n = 13). The most common reason for admission was pain (n = 30), and respiratory/dyspnea (n = 21). During the baseline period, mean 30-day readmission rate was 25.5% and 30-day mortality 19.6%. Preliminary data reveal early improvement in readmission and 30-day mortality (Table). Conclusions: We have demonstrated that identifying high-risk cancer patients using the electronic medical record is feasible and identifies a group at high risk for readmission and mortality. By prospectively identifying patients, we were able to provide a multi-pronged intervention at a tertiary hospital.[Table: see text]
Improving oncology patient medication knowledge through a systematic medication reconciliation process.
Authors: Pam Garza, Sabrina Q. Mikan, Linda H Yoder
Journal: Journal of Clinical Oncology (2022)

354 Background: Patient medication knowledge improves medication adherence. Lack of medication adherence leads to 125,000 deaths per year and $100-$299 billion in cost to the U.S. health care system. An Oncology Advanced Practice Provider (APP) conducted a quality improvement (QI) project to evaluate the effect of an educational review of medications to improve oncology patients’ knowledge regarding medication use. Methods: A QI project consisting of 60 patients seen during their regularly scheduled office visits was conducted. Patients received verbal instructions and written documentation about their medications; prescribed and over-the-counter. Evaluations were conducted and yes/no responses were recorded based on patients’ ability to answer four questions correctly: name of medication, reason for the medication, dosing schedule, and prescriber’s name. This was followed by a second visit using the same process. Results: Participants ranged in age from 42-87 (median = 67); most participants were female (N = 36), Caucasian (N = 37), and retired (N = 31). The total number of medications taken by the participants equaled 174, of which 130 were prescribed and 44 were over the counter medications or supplements. The most common prescribed medications were antiemetics (ondansetron and prochlorperazine) and pain medications (hydrocodone and oxycodone). Other prescribed medications included steroids, antihypertensives, and antiglycemics. The most common over the counter medications were Aspirin, Vitamin D, and multiple vitamins. A total of 612 Medication Reviews were completed. Of these reviews, on Visit I (Initial visit) 274 Educational reviews were required. On Visit II (post educational review) 169 Educational reviews were required. Patients needed 105 fewer educational reviews after the initial educational review. The average time between visits was two weeks. An unexpected finding was the lack of a complete and accurate record of medications taken by the participants as documented in their medical records. Conclusions: An Oncology APP led medication reconciliation process including an educational review showed improved medication knowledge among participants, although more than one review may be needed by some patients. Findings confirm the need for a systematic, comprehensive medication profile in the electronic medical record (EMR) to avoid medication errors in both administration and prescribing. An annual review of medications with patients is critical to their well-being.
A novel cannabis education clinic for patients with cancer: Patient characteristics from initial visit.
Authors: Dylan M. Zylla, Sarah Jax, Katherine Schmiechen, Katie Jelle, Grace Gilmore
Journal: Journal of Clinical Oncology (2022)

298 Background: Patients with cancer express growing interest in using cannabis to alleviate symptoms and want information from their oncology care teams. However, most oncology clinicians report insufficient knowledge to discuss potential benefits and risks of cannabis with patients. Methods: We created the Cannabis and Cancer Research and Education Clinic (CanCaRE) to educate patients interested in cannabis use through 1:1 video consultations with an oncology advanced practice clinician. We also developed an electronic registry built in REDCap that tracks outcomes including NCI PRO-CTCAE symptom questionnaires. All patients receive an intake survey with questions about their diagnosis, cancer treatments, current symptom burden, cannabis use history, and current medications. Results: During the first 18 months of the CanCaRE clinic, 103 of the 130 patients seen for consultation completed the intake survey. All 16 of our clinic’s medical oncologists had at least one patient receive a consultation. Patients had diverse cancer diagnoses (breast (19%), gynecologic (15%), lung (11%), pancreas (11%)) and were more often white (84%), not currently using cannabis (74%), and female (60%), with a median age of 64 (range 26-92). Most respondents (41%) had stage IV disease with the remaining 32% stage I-III (28% unknown). Table outlines symptom burden at time of initial CanCaRE consultation. The percentage of patients using medications for symptoms was high; non-opioid analgesics (81%), antiemetics (52%), anxiety/depression meds (52%), sleep meds (39%), and opioids (30%). The most common initial cannabis product recommendation included an oral tablet/solution (2.5mg THC/2.5mg CBD) twice daily as well as a THC-dominant vaporizer (3-5mg THC per puff) as needed. Conclusions: The development of a cannabis clinic to provide patients with cancer personalized education and dosing guidance is novel and helps serve an unmet need. Patients have diverse cancer histories and express a high level of symptom burden. Patients and oncology care teams report high satisfaction with our clinic model. Initial cannabis dosing recommendations used a “start low, go slow” titration plan. Analysis has begun on cannabis use patterns and changes in symptoms/concomitant medications to further tailor recommendations that are safe, effective, and cost-efficient. Exploring ways to expand this clinic model to other cancer centers is underway.[Table: see text]
Strategic team engagement for successful documentation of pain management.
Authors: Christine Bates, Erin Crum, Donald J. Brooks, Grant Andres
Journal: Journal of Clinical Oncology (2022)

53 Background: Pain is experienced by a majority of cancer patients, often having a significant negative impact on their quality of life. Effective documentation of pain scores and plan of care provide care teams with data for decision-making to improve pain management. In Q2 of 2021 documentation deficiencies were identified. Process improvement interventions were initiated through the remainder of 2021 to support clinical teams. Methods: Over the course of twelve months our practice sought to improve documentation of pain management through a multi-pronged approach. Execution began with initiation of the Quality and Safety Committee early in 2021 to engage key stakeholders. Our Chain of Command Project identified strategic members of the administrative and clinical leadership teams at the individual clinic level who initiated monthly meetings to promote quality awareness and engagement. Quality measures associated with pain management, MIPS 143 and 144, were examined with assistance from our Value Based Care Transformation Team. Monthly provider scorecard distribution commenced Q2 to identify documentation inconsistencies related to pain management. Providers, medical assistants, and scribes were provided education and training related to appropriate pain management documentation workflows. Follow up audits were performed by the Quality team. In Q3 and Q4 the Quality team collaborated with Human Resources to identify new employees and facilitate education on quality metric capture within a month of hire. Results: The data above is a representation of all clinics and patients treated. The interventions resulted in improved metrics from 2020 to 2022 YTD: MIPS 143 +5.5%, MIPS 144 +27.3%, and PIMSH4 +6.3%. Conclusions: Effective change management occurred from the top down with additional engagement of administrative and clinical members. Analysis of the internal structure and deficiencies was needed with implementation of metric training. Data transparency helped with engagement and managing documentation of MIPS 143 and 144. Next steps include leveraging the current documentation processes to improve PIMSH4, ultimately improving the quality of life for patients.[Table: see text]
Impacts on breast cancer screening by targeting high-risk individuals through the utilization of allied health members in rural India.
Authors: Sasmith Menakuru
Journal: Journal of Clinical Oncology (2022)

38 Background: Currently, screening in rural India is done in most instances by utilizing mobile detection units that the government of India sets up to reduce the barrier of accessibility. These screening camps infrequently occur and manage to screen around 100-150 people a day. Screening even with a positive result is ultimately useless without follow-up care. Breast cancer, which is often diagnosed late in presentation, is widely screened for by utilizing mobile mammography screening units. The authors propose that instead of recruiting patients randomly, patients should be chosen prior to the set-up of camps by using accredited social health workers (ASHAs), community health leaders (CHL), and other allied health professionals (AHP) based on risk factors. Methods: Mobile health screening camps were deployed in rural Andhra Pradesh, India, where for 2 screening sessions, females were recruited either a day before or just before set up. These results were compared to another 2 screening sessions where females were recruited for 2 weeks prior to being set up by ASHAs, CHLs, and other AHPs. They recruited patients at risk of breast cancer, including those with a family history, who were smokers, who felt a lump on self-examination, who had a prior history of cancer, and those with a BMI over 25. They explained about mammography, the need for them to be screened, and the need for follow-up care. Both data sets were compared to check for positivity rates on mammography and establishment of the initial follow-up appointment. Results: It was found that the screening camps where recruitment took place on the same day or the day before had a more significant number of patients who were recruited to get screened. In total, 267 people were screened that day. Out of those 267, mammography was positive in 21 patients; however, only 1 of those 21 patients established care at a follow-up visit. In the screening camps where ASHAs, CHL, and other AHPs were recruited to recruit patients based on high-risk factors, a total of 138 people were screened. Of those 138 people, 37 people had positive findings on mammography. Out of the 37 people, 29 patients established follow-up care. It was found that due to the decreased number of mammograms performed, the overall cost went down even with the need to allocate funding for recruitment. Conclusions: This study showed that it is beneficial to establish the recruitment process before setting up mammography camps by utilizing ASHAs, CHLs, and other AHPs to screen for high-risk individuals. Despite a more significant number of patients screened using the current widely utilized method of randomly recruiting patients in India, the follow-up rates were poor. By targeting high-risk women for mammography, the follow-up rates improve, and the overall cost of the screening camp decreases.
Pre-existing mental illness and guideline-concordant treatment for breast cancers among older women.
Authors: Manami Bhattacharya, Helen Parsons, Anne Hudson Blaes, Kathleen Call, Donna McAlpine
Journal: Journal of Clinical Oncology (2022)

138 Background: Guideline-concordant care (GCC) of breast cancer greatly improves survival. Women with mental illness experience worse survival after breast cancer; in this study, we examined whether women with mental illnesses pre-existing their breast cancer diagnosis receive GCC for breast cancer as often as women without. Methods: We used Surveillance and Epidemiology and End Results (SEER) cancer registry and Medicare claims (SEER-Medicare) to select cases of women (67+ years old) with Stage I-III breast cancers (n = 89,172). Mental illness was measured through diagnostic codes within 2 years before cancer diagnosis and categorized as serious mental illness (SMI: schizophrenia, bipolar disorder, depression with psychosis, and other psychotic disorders); depression or anxiety; or other mental illnesses. To determine receipt of GCC we used the National Comprehensive Cancer Network’s (NCCN) treatment guidelines, commonly referenced by oncologists as best practices. Outcomes included 1. surgery and radiation completion for all cancers (complete/incomplete treatment/no surgery); 2. surgery, radiation completion, and chemotherapy initiation (complete/incomplete/no surgery) for triple negative and HER2+ breast cancers; and 3. radiation completion after mastectomy for Stage III cancers with lymph involvement. We used generalized ordinal logistic regression to compare outcomes with mental illness categories, controlling for demographic, cancer-related, and clinical factors. Results: We found that 28.8% of women in this study had at least one diagnosis of a mental illness in the two years prior to their breast cancer diagnosis and 1.7% had SMI. Women with SMI are more likely to not receive surgery than women without (OR = 1.24, CI = 1.02-1.60). Women with mental illnesses have a higher risk of not completing radiation after breast conserving surgery (SMI: OR = 1.24, CI = 1.01-1.30, Depression and anxiety: OR = 1.11, CI = 1.06-1.16, other mental illnesses: OR = 1.09 CI = 1.01-1.16). Women with SMI and triple negative or HER2+ cancers are more likely to not complete all treatment (OR = 1.65, CI = 1.22-2.24). Conclusions: Women with mental illnesses may be at higher risk for incomplete treatment or lack of treatment initiation, especially for multi-part treatment, such as completion of radiation and initiation of chemotherapy, which may contribute to worse survival outcomes. Breast cancer and mental illness are both common illnesses among older women in the United States. Health systems should consider strategies for improving GCC among women with mental illness and breast cancer.
Real-world treatment patterns among patients with non-muscle invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guerin (BCG).
Authors: Neela Kumar, Hiremagalur parthasarathy Balaji, Bruno Emond, Ameur M Manceur, Isabelle Ghelerter, Dominic Pilon, Patrick Lefebvre, Nida Shafaat Imran, Lorie Ellis
Journal: Journal of Clinical Oncology (2022)

404 Background: Intravesical BCG is a common treatment in high-risk NMIBC patients; however supply constraints and regimen demands for patients have been reported and may impact long term patient outcomes. This study examined treatment patterns in NMIBC patients receiving intravesical BCG. Methods: Adults with NMIBC treated with intravesical BCG during any line of therapy (LOT) on or after the index date (first date for transurethral resection of the bladder tumor [TURBT] or initiation of intravesical therapy) were selected from de-identified IBM MarketScan Commercial and Medicare Supplemental Databases (1/1/2010-2/28/2021) and Multi-State Medicaid Database (1/1/2010-12/31/2019). Classification of NMIBC on the index date required that patients have no prior systemic antineoplastic therapy, radiotherapy, or cystectomy. Treatment patterns were evaluated from the index date until the end of the NMIBC phase (earliest of initiation of systemic antineoplastic therapy, cystectomy, radiotherapy, diagnosis for metastatic cancer, end of insurance eligibility, or end of data availability). Discontinuation of a LOT was defined as having a treatment gap &gt; 180 days for BCG (90 days for other agents) or switching to a new LOT. During each LOT, adequate BCG treatment was defined as having ≥5 claims during induction (first 42 days of treatment) and ≥2 claims during maintenance (beyond the first 42 days). Results: There were 5,410 NMIBC patients treated with BCG over a mean (median) follow up of 25.5 (18.9) months. The population was 79% male; mean age was 67 years. The majority of patients only received a single LOT (76%; TABLE). The predominant first LOT was BCG (93.1% of NMIBC patients); however, the majority (69.8%) did not receive adequate BCG induction/maintenance in first LOT. Nearly half (46.4%) of first LOT patients had reassessment for disease progression by TURBT. BCG retreatment after a six-month lapse was observed as the predominant second LOT, with &gt; 90% receiving inadequate BCG induction/maintenance. Conclusions: While intravesical BCG remains the most common therapy for NMIBC, less than a third of patients receive adequate BCG treatment in the first LOT; with this percentage further decreasing in the few patients who receive a subsequent LOT. In light of supply and demand constraints, results of this study further emphasize a need for additional treatment options that are effective, safe, and tolerable for patients with NMIBC.[Table: see text]